Order Form For Capacitive Charger

 Print Out & Mail in

Price is $295 for each charger plus $20 dollars shipping.

Shipping   Address:

Phone#:________________________

Name:__________________________________________________________

Address:________________________________________________________

City, State, Zip Code_______________________________________________

Email:___________________________

What system voltage are you using?  48volt____   72 volt____  96volts____  120 volts____  Other______________   

     # of Chargers                                                          Price

              _____________                                                                     ___________

                                                       Total:__________

Add $5 for each additional charger.  ---------------------- Shipping Total:__________

                                                                                             Grand Total: __________

Please send Cashiers Check,

Money Order or Personal check to:

Nile Cole

PO Box 654

Fairview,  Utah 84629